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35 Cards in this Set
- Front
- Back
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preconception counseling
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1. folic acid
2. rubella status 3. DM 4. hypothyroidism 5. HIV/AIDs 6. PKU 7. oral anticoagulant 8. are they on any anti-epiletic drugs 9. isoteinoins (accutant) 10. smoking, alcohol, drugs 11. obesity 12. STDs |
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indications for genetic counseling
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1. known or suspected genetic diseas
2. > 35 y/o 3. teratogen exposure 4. ethnic bkgd 5. recurrent preg loss 6. abnl shown on sonogram 7. fh of early onset cancer |
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intial office visit-comprehensive H&P
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-prior OG hx
-# of miscarriages -complications -C-sections -size of baby |
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initial labs
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1. pap
2. CBC with diff (lok for anemia) 3. syphilis screen 4. HepBs 5 rubella 6. RH and AB screen 7. UA/C & S (asym UTIs) |
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optional testing
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gonorrhea/chlamydia, HIV, herpes, PPD, fasting blood sugar, tay sach, varicella,
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nageles rule
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LMP - 3 month + 7 days
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calculation of gestational age
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-preg wheel
-size of uterus: 12 wks at pubic symphysis -fundus at umbilicus at 20 weeks, after that measure with tape measure and it should correlate with gest age -20 wks mom feel movement -U?S- 5 wks fetal pole; 7-8wks fetal heart tones |
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routine vist-hx
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-fetal movement
-contraction or ab pain -vag bleeding -leakage of fluid -swelling |
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routine visit- PE
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-BP
-wt -urine drip -fundal ht -FHR (dopple at 12 wks- 120-160 bpm) -leopolds maneuver |
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leoplds maneuver
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1: what occupies the fundus
2. what side is the back 3. which part is over pelvic inlet (head is hard) 4. what side is the cephalic prominence? |
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routine testing
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1. 12-13 wks: nuchal transleucency and biochemical markers
2. 16-20 wks: sonogram; triple screen (for down syndrome or a neural tube defect), amniocentesis (if >35) 3. 24-28 wks: glucose challenge test; 3 hr GTT; admin rhogam if RH- |
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testing at 36-38 wks
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-group beta step cultur
-CBC -VDRL -herpes -gon/chlamydia culture -HIV |
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tesing at 40+ weeks
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- all tests looking for signs of baby being compromised and if they need to be induced
-nonstress test (2/wk) -biophysical profile ultrasound (fetal breathing, movement, tone; amniotic fluid index) |
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frequency of visit
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every 4 weeks until 28 wks
every 2 weeks 28-36 wks every wk beyond 36 wks |
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contractions of false labor
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-Occur @ irregular intervals
-Intensity unchanged -No change in cervical dilation (KEY) (if truly in later the cervix will change size) -Discomfort mainly in lower abdomen -Relieved by sedation (will go to sleep and not even feel contractions) |
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contractions of true labor
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-Occur @ regular intervals
-Interval gradually shortens -Intensity gradually increases -Cervix dilates (change from 2 -3 -4…) -Discomfort in back & entire abdomen -No relief with sedation -Is patient cant talk or don’t want to be talked too |
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dilation
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expressed in cms, use fingers
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effacement
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thickness
-as women contracts cervix is brought up and starts getting shorter and thinner (how many cm do you feel around your fingers?) -expressed in percentage (o& uneffaced or 100% paper thin) -subjective, change over time is most important |
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station
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about the presenting part; inrelation to ischial spines (-3 to +3)
-find ischial spine and try to feel hard --> is head is had the same level -0; +5 is crowning |
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position of fetus
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-run fingers along babys head and fontinel: you will be able to know id the baby is facing down or up
-impt because diameter of babys head changes depending on the way iti s facing -best for head to be facing ground |
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fetal presentations
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LOA: left occiput anterior: baby has his or her back on the mother's left side. The baby faces between the right hip and the spine of his or her mother
LOP: left occiput posterior--> not good LOT: left occiput transverse |
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stages of labor
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-First Stage: From onset of contractions to fully dilated
-Second Stage: From fully dilated to delivery of baby -Third Stage: From birth to delivery of placenta -Fourth Stage: recovery; vague (some says 6 weeks post partum, some say it is just a couple hour after delivery) |
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mgmt of first stage
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-monitor fetal heart tones
-freq of contractions -vaginal exam -examine every 1 hr to 2 hrs to see if there is cervical change |
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friedmans curve
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Within first stage there is phases: latent, active, dilation, second
-4 cm→ big change→ usually when they admit patients |
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friedmans curve avgs for nulliparous
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Latent: 20 hrs
active: 12 hrs dilation in cm/hr: 1.2 second stage 2.5 hrs (pushing_ |
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friedmans curve avgs in multiparous women
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Latent: 14 hrs
Active: 7 dilation: 1.5 cm/hr second stage: .5 hrs |
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cardinal movements in labor
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engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
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non-pharmical methods
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-continuous labor support
-water immersion -maternal movement and positioning -touch and massage -heat/cold -acupuncture -hypnosis -relaxation/breathing |
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pharm methods: first stage of labor
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1. epidurals: catheter into epidural space
2. spinal: no catheter, just a dose of meds, more used for C/S and abrasions 3. combine spinal-epidural: (“walking epideral”- initially give a spinal but an epideral catheter is placed at same time and later given meds 4. systemic: opoids, go into baby; want to deliver baby within 1st hr of after 4hrs b/c baby can become depressed and have respiratory issues |
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pharm methods: second stage of labor
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-local for episiotomy
-pudenal block |
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indications of epiostomy
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1. facilitate delivery
2. inevitable tear 3. forceps/vacuum/breech pros: surgical incision can be repaired better than jaged tear cons: increases incidence of 3rd and 4th degree extension, blood loss, dyspareunia, pain postpartum, rate of infx |
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perineal lacerations
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-First degree: Involving the vaginal mucosa or perineal skin
-Second Degree: Involving the subepithelial tissues of the vagina with or without the perineal body -Third Degree: Involving the anal sphincter -Fourth Degree: Involving the rectal mucosa exposing the lumen of the rectum |
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3rd stage of preg
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-placenta separation usually occurs within 5 min, should not last longer than 30 min (if longer need to do it manually)
-signs of separation -umbilical cord legthening -"gush" of blood -firm and rising uterus |
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postpartum orders
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-Admit to RR then PP floor
-Dx s/p NSVD -Condition good -Vitals apr -Activity OOB (out of bed) as tolerated -Nursing Breast & Perineal Care -Diet Regular -IVF 20U of Pitocin in 1LR @ 125cc/hr x 2 (given to help uterus contract to avoid bleeding) -Meds tylenol 650mg po q4-6hrs prn pain -Percocet i-ii tabs po q 4-6hrs prn pain -Allergies Penicillin -Labs CBC in am |
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4th stage of labor: postpartum care
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-6-8 wks
-initial concerns: postpartum hemorrhage, fever, uterine pain, dysuria, breast problems, leg pain or swelling -long term: lactation, baby blues, wt |
